Rabies: beware of the dog

Sikkim is about to be certified as the first rabies-free state in India.1 This is thanks to a innovative state-wide campaign to vaccinate dogs. This was carried out by Vets Beyond Borders, an Australian non-profit organisation, with the support of the Sikkim government and the National Centre for Disease Control.

India is estimated to have the highest incidence of rabies globally, with 30 000 of the world’s 50 000 cases reported each year.2 India has 36% of the global and 65% of the Asian rabies burden in terms of cases.3 Control of rabies is a priority for the Indian government, according to its 12th five year plan (2012-17), but the population remains vulnerable because of shortages of anti-rabies vaccine,4 and once symptoms appear, dog rabies virus is universally fatal in humans.

In contrast to the West, where other mammals such as bats and racoons are implicated in transmission, stray dogs comprise the predominant reservoir for the rabies virus in the developing world. In Mumbai, 82 247 cases of dog bites were reported in 2012.5 Someone is bitten by a dog every two seconds in India and someone dies from rabies every 30 minutes on average.6 But because rabies is not a notifiable disease here the actual burden is likely to be even greater.

This makes rabies an endemic public health nuisance to visitors as well as the local population, and the disease is spreading to neighbouring countries where it is not yet endemic.7